Kułach Andrzej, Kucio Michał, Majewski Michał, Gąsior Zbigniew, Smolka Grzegorz
Department of Cardiology, SHS, Medical University of Silesia, Ziolowa 47, 40-635 Katowice, Poland.
2nd Division of Cardiology, Upper-Silesian Medical Center, 40-752 Katowice, Poland.
J Clin Med. 2025 Apr 12;14(8):2649. doi: 10.3390/jcm14082649.
COVID-19 is associated with various arrhythmias that continue into a post-COVID period and become a concern for patients and healthcare a long time after the infection. This study aimed to assess the incidence of arrhythmias and their relationship to presented symptoms in patients with no history of rhythm disturbances who underwent severe COVID-19 within the past 6 months. A total of 54 severe COVID-19 survivors with no history of known arrhythmia were enrolled in the study 3-6 months after discharge. All subjects underwent echocardiography, 24 h Holter monitoring, and received a handheld ECG event recorder for 14 days of ambulatory single-lead ECG recording, which was evaluated for supraventricular and ventricular arrhythmias and patient-reported events. After 12 months of follow-up (FU), Holter monitoring and ECG recordings were repeated. The incidence of palpitations was high at baseline and halved after 12 months (65% vs. 36%, = 0.018), as was the symptom-induced utilization of the event monitor (36% vs. 12%, p0.012). Palpitations were more common in patients with CAD, diabetes, and hypertension, but were not related to any rhythm disturbances except sinus tachycardia (OR of 5.8 for each 10 bpm increase in HR; CI: 1.3-26.5, = 0.02). Holter monitoring revealed a higher burden of PVCs 3-6 months after COVID vs. FU (PVCs > 200/d in 36% vs. 17%, < 0.05), and PVCs were more commonly recorded events in symptomatic patients. Symptomatic subjects more frequently reported sinus tachycardia (48% vs. 13%, < 0.05) and PVC (21% vs. 0%, < 0.05). Neither arrhythmias nor palpitations were related to the severity of the infection. Palpitations are common after severe COVID-19, but the symptoms are related to sinus tachycardia rather than actual arrhythmia and are more pronounced in patients with cardiovascular conditions. Ventricular ectopy was the predominant finding early after severe COVID-19 and might have been responsible for symptoms in a fraction of symptomatic subjects. Both symptoms and sinus tachycardia resolved over time.
新冠病毒病（COVID-19）与多种心律失常有关，这些心律失常会持续到新冠后时期，并在感染后的很长一段时间内成为患者和医护人员关注的问题。本研究旨在评估在过去6个月内经历过重症COVID-19且无心律失常病史的患者中，心律失常的发生率及其与所出现症状的关系。共有54名无已知心律失常病史的重症COVID-19幸存者在出院后3至6个月被纳入研究。所有受试者均接受了超声心动图检查、24小时动态心电图监测，并获得了一个手持式心电图事件记录仪，用于进行14天的动态单导联心电图记录，以评估室上性和室性心律失常以及患者报告的事件。在随访12个月后，重复进行动态心电图监测和心电图记录。心悸的发生率在基线时较高，12个月后减半（65%对36%，P = 0.018），症状诱发的事件监测仪使用率也是如此（36%对12%，P<0.012）。心悸在患有冠心病、糖尿病和高血压的患者中更为常见，但除窦性心动过速外，与任何心律失常均无关联（心率每增加10次/分钟，比值比为5.8；可信区间：1.3 - 26.5，P = 0.02）。动态心电图监测显示，与随访时相比，COVID-19后3至6个月室性早搏的负担更高（室性早搏>200次/天的情况，36%对17%，P<0.05），且室性早搏在有症状的患者中更常被记录到。有症状的受试者更频繁地报告窦性心动过速（48%对13%，P<0.05）和室性早搏（21%对0%，P<0.05）。心律失常和心悸均与感染的严重程度无关。重症COVID-19后心悸很常见，但症状与窦性心动过速有关，而非实际的心律失常，且在有心血管疾病的患者中更为明显。室性早搏是重症COVID-19后早期的主要发现，可能是一部分有症状受试者症状的原因。症状和窦性心动过速均随时间而缓解。
